Towards the end of the first article of this series, I suggested that you attend to the experience of the “Urge”, which is what you feel, think and do when you turn away from adherence. I didn’t give you much of an explanation of why you should be doing this, other than using the exercise as a way to clarify and then target the exact form that self-obstruction takes in you. Not a bad reason. In this article however, I intend to do even better. Examination of the “Urge” has many other benefits. Learning about more of these benefits can motivate you to continue your examination and can show you how to use the examination of the “Urge” to benefit your patients.
SOME BENEFITS OF EXAMINING YOUR “URGE”
1) BETTER COMMUNCATION: Whether we are practitioners with patients, parents with children, family with other family members or friends with friends, when we try to help those we care about, the quality of our communication matters more than what we have to say. If those we are trying to help experience caring, respect and empathy from us, they will be much less likely to resist what we are offering. The reverse, unfortunately, is also true: when they experience indifference, disrespect and lack of compassion, they may even develop resistance to suggestions they were willing to accept before the “helper” poisoned the relationship.
I believe that practitioners can be so excited by the information they know can benefit the patient, that placing the information before the patient becomes the only focus. Doing so accurately, succinctly and thoroughly is prized. However, without caring, respect and empathy, the net effect is often like being brilliant in an empty room.
Most practitioners are caring, well-intended individuals. How is it then, that the image of the warm healer is seen as such a rare commodity? There are many reasons, including the unrealistic expectations of some patients. Another reason is a cycle that begins with the depth of the practitioners desire to help. Over time, as the practitioner encounters patients who do not comply (for reasons completely independent of the practitioner), the practitioner begins to get frustrated, annoyed and even angry. To protect themselves and their patients from these feelings, the practitioner (unconsciously) withdraws emotionally, becomes distant. The patients then sees only what’s on the surface – uncaring, cold, perhaps disrespectful, un-empathic behavior and responds accordingly. This, in turn, leaves the practitioner feeling unappreciated, perhaps disrespected and unseen. Quite a mess, huh? What are the odds of good communication in the midst of this?
What to do? Match your own experience to your patients. Hence, in the issue of adherence to a healthy life style, begin with the experience of your “Urges.” Struggle as you ask them to struggle. If you are not diabetic the task of empathy becomes somewhat greater. However, at the risk of saying the ridiculously obvious, there is no single “diabetic experience”. Your struggle will still match that of your patients to a degree sufficient to facilitate caring, respect and empathy. We all find it easier to care about those we see as struggling than those we see as being stubborn, irresponsible, short sighted, stupid, unreasonable, infantile…… you get the picture. As we struggle ourselves, we get a first-hand experience of the difficulties of adherence. As we recognize how hard it can be, we can respect the problem and those who struggle with it.
Conveying caring, respect and empathy doesn’t guarantee adherence. But it does increase the probability.
2) GETTING YOUR REACTION TO THE SUGGESTION: The suggestion was made to examine the experience of your “Urges”. How did you react to the suggestion? Did you push against it or move towards it? I know you don’t have as much information about exactly how to examine your “Urge” as yet but there is enough to get started and to have an initial response. What was yours?
If you have moved towards my suggestion – congratulations! I trust that the investigation of your “Urge” has been interesting. If you have not begun some investigation, I suggest you ask yourself why and listen very carefully to the reasons you provide. Have you heard a similar response from your patients?
I don’t intend to be tricky or manipulative here. I do intend to focus upon experience, not just intellectual knowledge of right and wrong, as the mechanism to increase adherence.
Wouldn’t it be interesting to share the story of your reluctance to take my suggestion with some reluctant patients? The story doesn’t have to have a happy ending, with you conquering self-obstruction. It can just be a shared experience of difficulty – and be very useful to your patient. Wouldn’t it also be interesting to ask patients what their initial reaction is to your suggestions? Do they move towards or move away?
3) BREAKING THE HABIT: There is no doubt that maintaining proper and stable blood glucose levels significantly reduces the impact of diabetes-related complications. Yet the moment to moment experience of an “Urge” or temptation or desire etc. is usually one where the thought to eat poorly or not exercise is present, some weak (sometimes unheard), inner voice suggests that this might not be a good idea and then the hands are delivering the food to the mouth or you’ve “decided” not to go to the gym right now. Anything that can interrupt, slow down or disrupt this procedure is a good thing. Trying to shut it out, or just saying stop, has little long-term value. Training ourselves and our patients to attend carefully to the emergence of the “Urge”, to make that weak voice of protest louder, interrupts the habit. Like Judo, you go with the force, not against it.
I have respect for the difficulties of deeply examining the experience of the “Urge.” I hope this article encourages you to try. To, at least, think about it from time to time. The next article will provide some examples of what others have found during their examinations and where it has taken them. At the horrific risk of sounding like my 7th grade teacher, you’ll get more out of this if you do your “homework.” You can match your responses to those of others.
Leonard Lipson, M.A. received his Bachelors degree in Psychology from Adelphi University and his Masters in Psychology from the New School for Social Research. He received four years of post-graduate education from The American Institute for Psychotherapy and Psychoanalysis. He has been in the private practice of psychotherapy for the past 29 years, with offices in Manhattan and Suffern, N.Y Mr. Lipson created the Medical Adherence Training program in 1995. The program helps people adhere to what is medically recommended. The program now serves patients throughout the U.S. and is in the process of being put into book form.
Mr. Lipson is a member of the Rockland County Psychological Society, The Society for Behavioral Medicine and The NYS Mental Health Counselors Association.